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\u56fe 26-2<\/p>\n
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\u56fe 26-3<\/p>\n
(\u56fe\u6ce8)\uff1aR\u6ce2\u65f6\u9650\u6307\u6570\u53caR\/S\u6ce2\u5e45\u6307\u6570\u8ba1\u7b97\u65b9\u5f0f\u3002A: QRS\u6ce2\u603b\u65f6\u9650\uff0cB: VI\u6216V2\u5bfc\u8054R\u6ce2\u65f6 \u9650\uff1bC:V1\u6216V2\u5bfc\u8054R\u6ce2\u9ad8\u5ea6\uff1bD: VI\u6216V2\u5bfc\u8054S\u6ce2\u6df1\u5ea6\u3002(\u672c\u56fe\u5f15\u81eaOuyang F, Fotuhi P, Ho SY, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: Electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol, 2002, 39: 500-508 )<\/p>\n<\/p>\n
\u56fe 26-4<\/p>\n
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\uff08\u56fe\u6ce8\uff09\uff1aV2\u5bfc\u8054\u8f6c\u6362\u7387\u8ba1\u7b97\u65b9\u5f0f\u3002A:\u5ba4\u6027\u65e9\u640f\u65f6V2\u5bfc\u8054R\u6ce2\u65f6\u95f4\u95ee\u671f\uff1bB:\u5ba4\u6027\u65e9\u640f\u65f6V2\u5bfc \u8054R\u6ce2\u9ad8\u5ea6\uff1bC:\u5ba4\u6027\u65e9\u640f\u65f6V2\u5bfc\u8054S\u6ce2\u6df1\u5ea6\uff1bD:\u5ba4\u6027\u65e9\u640f\u65f6V2\u5bfc\u8054S\u6ce2\u65f6\u95f4\u95f4\u671f\uff1bE:\u7aa6\u5f8b\u65f6V2 \u5bfc\u8054R\u6ce2\u9ad8\u5ea6\uff1bF:\u7aa6\u5f8b\u65f6V2\u5bfc\u8054S\u6ce2\u6df1\u5ea6\u3002\uff08\u672c\u56fe\u5f15\u81eaBetensky BP, Park RE, Marchlinski FE, et al. The V2 Transition Ratio: A New Electrocardiographic Criterion fbr Distinguishing Left From Right Ventricular Outflow Tract Tachycardia Origin. J Am Coll Cardiol, 2011, 57: 2255-2262\uff09<\/p>\n
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\uff08\u56fe\u6ce8\uff09\uff1a\u5de6-\u53f3\u51a0\u7aa6\u4ea4\u754c\u5904\u8d77\u6e90\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u4f53\u8868\u5fc3\u7535\u56fe\u7279\u70b9\u3002\u4f53\u8868\u5fc3\u7535\u56fe\u7279\u70b9\u7b26\u5408\u6d41\u51fa\u9053\u8d77\u6e90\u5ba4 \u6027\u5fc3\u5f8b\u5931\u5e38\u7279\u70b9\uff0c\u5176VI\u5bfc\u8054\u4e0a\u5448QS\u5f62\u6001\u4e14\u4e0b\u964d\u652f\u90e8\u5206\u7c97\u949d,\u79fb\u5f62\u5bfc\u8054\u4f4d\u4e8eV3\u3002\uff08\u672c\u56fe\u5f15\u81eaBala R, Garcia FC, Hutchinson MD, et al. Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right\/left coronary cusp commissure. Heart Rhythm, 2010, 7: 312-322.\uff09<\/p>\n<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u4e3b\u52a8\u8109\u74e3-\u4e8c\u5c16\u74e3\u4ea4\u754c\u5904\u8d77\u6e90\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u4f53\u8868\u5fc3\u7535\u56fe\u7279\u70b9\u3002VI\u5bfc\u8054QRS\u5448qR \uff08\u7bad\u5934\uff09\uff0c \u5176\u4f59\u80f8\u524d\u5bfc\u8054\u5448 R \u6ce2 Rs \u578b\u3002\uff08\u672c\u56fe\u5f15\u81ea Lin D, Ilkhanoff L, Gerstenfeld E et al. Twelve-lead electrocardiographic characteristics of the aortic cusp region guided by intracardiac echocardiography and electroanatomic mapping. Heart Rhythm, 2008, 5: 663-669 \uff09<\/p>\n
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\u56fe 26-9<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u4e3b\u52a8\u81094\u826e\u90e8\u9020\u5f71\u53caCT\u5f71\u50cf\u91cd\u5efa\u660e\u786e\u5de6\uff08LCC\uff09\u3001\u53f3\uff08RCC\uff09\u53ca\u65e0\u51a0\u7aa6\uff08NCC\uff09\u7684\u7a7a\u95f4\u4f4d \u7f6e\u3002\u5de6\u524d\u659c60\u00b0\uff08 LA060\u00b0 \uff09\u53ca\u53f3\u524d\u659c30\u00b0\uff08 RAO30\u00b0\uff09\u4e0b\u663e\u793a\uff0c\u5de6\u51a0\u7aa6\u4f4d\u4e8e\u4e3b\u52a8\u8109\u826e\u90e8\u6700\u5de6\u3001\u6700\u9ad8\u4f4d\uff0c\u53f3 \u51a0\u7aa6\u4f4d\u4e8e\u4e3b\u52a8\u8109\u6839\u90e8\u6700\u53f3\u7f18\uff0c\u4f4e\u4e8e\u5de6\u51a0\u7aa6\uff1b\u65e0\u51a0\u7aa6\u4f4d\u4e8e\u4e3b\u52a8\u8109\u6839\u90e8\u7684\u6700\u540e\u3001\u6700\u4e0b\u7f18\u3002\uff08\u672c\u56fe\u5f15\u81eaTakeshi S, Hitoshi H, Kenzo H et al. Utility of distinctive local electrogram pattern and aortographic anatomical position in catheter manipulation at coronary cusps. J Cardiovasc Electrophysiol, 2011, 22: 521-529 \uff09<\/p>\n<\/p>\n
\u56fe 26-10<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u4e3b\u52a8\u8109\u6839\u90e8\u4e09\u4e2a\u7aa6\u5185\u5fc3\u5185\u7535\u56fe\u7279\u70b9\u3002\u5de6\u56fe\u4e0e\u4e2d\u592e\u56fe\u5206\u522b\u5de6\u51a0\u7aa6\uff08LCC\uff09\u4e0e\u53f3\u51a0\u7aa6\uff08RCC\uff09 \u7aa6\u5f8b\uff08PR\u6807\u8bb0\uff09\u4e0e\u5ba4\u6027\u65e9\u640f\uff08\u661f\u53f7\u6807\u8bb0\uff09\u65f6\u5fc3\u5185\u7535\u56fe\u7279\u70b9\uff0c\u53ef\u8bb0\u5f55\u5230\u9ad8\u632f\u5e45\u7684\u5fc3\u5ba4\u7535\u4f4d\uff0c\u76f8\u5bf9\u4f4e\u5e45\u7684\u5fc3 \u623f\u6ce2\u3002\u53f3\u56fe\u4e3a\u65e0\u51a0\u7aa6\uff08NCC\uff09\u7aa6\u5f8b\u4e0e\u623f\u6027\u65e9\u640f\u65f6\u5fc3\u5185\u7535\u56fe\u7279\u70b9\uff0c\u8bb0\u5f55\u5230\u4f4e\u5e45\u5fc3\u5ba4\u7535\u4f4d\u53ca\u9ad8\u5e45\u5fc3\u623f\u6ce2\uff0c\u672a \u8bb0\u5f55\u5230\u5e0c\u6c0f\u675f\u7535\u4f4d\u3002\uff08\u672c\u56fe\u5f15\u81ea Takeshi S, Hitoshi H, Kenzo H et al. Utility of distinctive local electrogram pattern and aortographic anatomical position in catheter manipulation at coronary cusps. J Cardiovasc Electrophysiol, 2011, 22: 521-529 \uff09<\/p>\n<\/p>\n
\u56fe26\u30fb11<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u501f\u52a9X\u5f71\u50cf\u5de6\u524d\u659c60\u3002\uff08LA060\u00b0 \uff09\u53ca\u53f3\u524d\u659c30\u00b0 \uff08 RA030\u00b0\uff09,\u660e\u786e\u653e\u7f6e\u5728\u5de6\u3001\u53f3\u53ca\u65e0\u51a0 \u7aa6\u4e0e\u5e0c\u6c0f\u675f\uff08His\uff09\u3001\u5fc3\u5927\u9759\u8109\uff08GCV\uff09\u5bfc\u7ba1\u7684\u7a7a\u95f4\u4f4d\u7f6e\u3002\u5de6\u51a0\u7aa6\uff08LCC\uff09\u6700\u9760\u8fd1GCV\u7535\u6781\uff0c\u53f3\u51a0\u7aa6\uff08RCC\uff09 \u4e0e\u65e0\u51a0\u7aa6\uff08NCC\uff09\u9760\u8fd1\u5e0c\u6c0f\u675f\uff08HB\uff09\u7535\u6781\uff0c\u53f3\u4e0b\u89d2\u5bf9\u5e94\u4e09\u4e2a\u51a0\u72b6\u7aa6\u5185\u5fc3\u5185\u7535\u56fe\uff0c\u4e0e\u56fe10\u7ed3\u679c\u7c7b\u4f3c\u3002\uff08\u672c \u56fe\u5f15\u81ea Takeshi S, Hitoshi H, Kenzo H et al. Utility of distinctive local electrogram pattern and aortographic anatomical position in catheter manipulation at coronary cusps. J Cardiovasc Electrophysiol, 2011, 22: 521-529\uff09<\/p>\n
3.\u6fc0\u52a8\u6807\u6d4b \u6fc0\u52a8\u6807\u6d4b\u91c7\u7528\u9010\u70b9\u6fc0\u52a8\u987a\u5e8f\u6807\u6d4b\u786e\u5b9a\u6709\u6548\u9776\u70b9\uff0c\u6709\u6548\u9776\u70b9\u5728\u53cc\u6781\u7535\u56fe\u4e0a\u901a\u5e38\u80fd\u9886\u5148\u5ba4 \u6027\u5fc3\u5f8b\u5931\u5e38\u4f53\u8868\u5fc3\u7535\u56feQRS\u6ce2\u8d77\u59cb20ms\u4ee5\u4e0a\uff0c\u5355\u6781\u7535\u56fe\u5448QS\u578b\u3002\u9700\u8981\u6ce8\u610f\u4ee5\u4e0b\u4e8b\u9879\uff1a\u2460\u6807\u6d4b\u4e3b\u52a8\u8109 \u6839\u90e8\u9700\u8981\u6ce8\u610f\u5c40\u90e8\u5fc3\u5ba4\u53cc\u7535\u4f4d\u7684\u5b58\u5728\uff0c\u90e8\u5206\u6ce2\u5e45\u8f83\u5c0f\u7684\u7535\u56fe\uff0c\u53ef\u901a\u8fc7\u653e\u5927\u591a\u5bfc\u7535\u751f\u7406\u4eea\u7684\u589e\u76ca\u53d1\u73b0\uff0c\u5176 \u4e2d\u5c16\u9510\u9ad8\u9891\u7684\u4ee3\u8868\u8fd1\u573a\u7535\u4f4d\uff0c\u5706\u987f\u4f4e\u9891\u7684\u5219\u4ee3\u8868\u8fdc\u573a\u7535\u4f4d\u3002\u7aa6\u5f8b\u65f6\uff0c\u4e8e\u4e3b\u52a8\u8109\u6839\u90e8\u90e8\u5206\u75c5\u4f8b\u53ef\u6807\u6d4b\u5230\u8fdc \u573a\u5706\u987f\u4f4e\u9891\u7684\u6d41\u51fa\u9053\u7535\u4f4d\u9886\u5148\u8fd1\u573a\u5c16\u9510\u9ad8\u9891\u7684\u5c40\u90e8\u808c\u8896\u7535\u4f4d\uff0c\u8d77\u6e90\u4e8e\u4e3b\u52a8\u8109\u6839\u90e8\u7684\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u53d1\u751f\u65f6, \u5c16\u9510\u9ad8\u9891\u7684\u8fd1\u573a\u7535\u4f4d\u4e0e\u5706\u987f\u4f4e\u9891\u7684\u8fdc\u573a\u7535\u4f4d\u53d1\u751f\u53cd\u8f6c\uff08\u56fe26-12\uff09\uff1b\u5fc3\u5ba4\u53cc\u7535\u4f4d\u95f4\u671f\u4e00\u822c\u5f88\u77ed\uff0c\u4e24\u8005\u5e38\u878d \u5408\uff0c\u5c11\u6570\u60a3\u8005\u53ef\u5b58\u5728\u660e\u663e\u7684\u7b49\u7535\u4f4d\u7ebf\uff1b\u2461\u5355\u6781\u6807\u6d4b\u53ef\u63d0\u4f9b\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u4f20\u5bfc\u6ce2\u9635\u7684\u65b9\u5411\uff0c\u5f53\u6807\u6d4b\u7535\u6781\u4f4d \u4e8e\u6216\u63a5\u8fd1\u8d77\u6e90\u70b9\u65f6\uff0c\u53ef\u8bb0\u5f55\u5230\u4e00\u4e2aQS\u5f62\u5355\u6781\u8154\u5185\u56fe\u3002\u5728\u4e3b\u52a8\u8109\u6839\u90e8\u8d77\u6e90\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u7684\u5bfc\u7ba1\u6d88\u878d\u4e2d\uff0c\u5355 \u6781\u6807\u6d4b\u53ef\u7ed3\u5408\u53cc\u6781\u6fc0\u52a8\u6807\u6d4b\u7684\u7ed3\u679c\u4ee5\u63d0\u9ad8\u6d88\u878d\u6210\u529f\u7387\uff08\u56fe26-12,\u56fe26-13\uff09 o<\/p>\n<\/p>\n
\u56fe 26-12<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u4e3b\u52a8\u8109\u6839\u90e8\u5ba4\u6027\u65e9\u640f\u6210\u529f\u6d88\u878d\u9776\u70b9\u7535\u4f4d\u53cd\u8f6c\u7279\u70b9\u3002A\u56fe\u4e3a\u6d88\u878d\u524d\u7aa6\u5f8b\uff08\u5de6\u56fe\uff09\u4e0e\u5ba4\u6027\u65e9 \u640f\uff08\u53f3\u56fe\uff09\u5fc3\u5185\u7535\u56fe\uff0c\u7aa6\u5f8b\u65f6\u53cc\u6781\u7535\u6781\u8fdc\u7aef\uff08ABL-d\uff09\u5fc3\u5ba4\u6ce2\u540e\u6709\u4e00\u7535\u4f4d\uff08\u5b9e\u7ebf\u7bad\u5934\uff09,\u5728\u5ba4\u6027\u65e9\u640f\u8be5\u7535 \u4f4d\u51fa\u73b0\u5728\u5fc3\u5ba4\u6ce2\u524d\uff08\u865a\u7ebf\u7bad\u5934\uff09\u3002B\u56fe\u4e3a\u6210\u529f\u6d88\u878d\u540e\u6240\u5904\u8019\u70b9\u5904\u8bb0\u5f55\u7684\u7aa6\u5f8b\u5fc3\u5185\u7535\u56fe\uff0c\u6d88\u878d\u524d\u540e\u6bd4\u8f83\u53d1 \u73b0\uff0c\u8be5\u7535\u4f4d\u51fa\u73b0\u5728\u5fc3\u5ba4\u6ce2\u4e4b\u540e\u5e76\u5ef6\u8fdf\uff0c\u5355\u6781\u7535\u56fe\uff08ABL.uni\uff09\u5448QS\u578b\u3002His-P=\u5e0c\u6c0f\u675f\u7535\u6781\u8fd1\u7aef\uff0cHis-d= \u5e0c\u6c0f\u675f\u7535\u6781\u8fdc\u7aef\uff0cCS\u30fbP=\u51a0\u72b6\u9759\u8109\u7aa6\u7535\u6781\u8fd1\u7aef\uff0cCS-d=\u51a0\u72b6\u9759\u8109\u7aa6\u7535\u6781\u8fdc\u7aef\uff0cRVA=\u53f3\u5fc3\u5ba4\u5fc3\u5c16<\/p>\n<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u4e3b\u52a8\u8109\u74e3.\u4e8c\u5c16\u74e3\u4ea4\u754c\u5904\u5ba4\u6027\u65e9\u640f\u6d88\u878d\u9776\u70b9\u7684\u7535\u751f\u7406\u4e0e\u5f71\u50cf\u7279\u70b9\u3002\u56feA\u4e3a\u4f53\u8868\u5fc3\u7535\u56fe\uff0cB \u56fe\u4e3a\u8d77\u640f\u5fc3\u7535\u56fe\uff0cC\u56fe\u793a\u5fc3\u5185\u7535\u56fe\u63d0\u793a\u9776\u70b9\uff08ABL\uff09\u5c40\u90e8\u5fc3\u5ba4\u6ce2\u9886\u5148\u4f53\u8868\u5fc3\u7535\u56feQRS\u6ce2\uff08Vo.QRS\uff0932ms, \u53f3\u5ba4\u6d41\u51fa\u9053\u5fc3\u5ba4\u6ce2\uff08RVOT\uff09\u4e0d\u9886\u5148\uff0c\u5355\u6781\u7535\u56fe\u5448QS, D\u56fe\u793aX\u7ebf\u5f71\u50cf\u56fe\u6d88\u878d\u5bfc\u7ba1\uff08ABL\uff09\u4f4d\u4e8e\u4e3b\u52a8\u8109 \u74e3-\u4e8c\u5c16\u74e3\u4ea4\u754c\u5904\u7a0d\u4e0a\u65b9\uff0c\u9020\u5f71\u5bfc\u7ba1\u4f4d\u4e8e\u5de6\u4e3b\u5e72\uff08LMCA \uff09\uff08\u672c\u56fe\u5f15\u81eaKumagaiK, FukudaK, WakayamaY, et al. Electrocardiographic characteristics of the variants of idiopathic left ventricular outflow tract ventricular tachyarrhythmias. J Cardiovasc Electrophysiol, 2008, 19:495-501 \uff09<\/p>\n
4.\u8d77\u640f\u6807\u6d4b\u5f53\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u5076\u5c14\u53d1\u4f5c\u65f6\uff0c\u5e38\u7528\u7684\u65b9\u6cd5\u662f\u5728\u4f53\u8868\u5fc3\u7535\u56fe\u9884\u6d4b\u7684\u8d77\u6e90\u533a\u57df\u5185\u76f4\u63a5\u91c7\u7528 \u8d77\u640f\u6807\u6d4b\u5bfb\u627e\u7406\u60f3\u9776\u70b9\u3002\u901a\u8fc712\u5bfc\u8054\u5fc3\u7535\u56feR\u6ce2\u5207\u8ff9\u548cR\/S\u6ce2\u6bd4\u503c\uff0c\u6bd4\u8f83\u6700\u5c0f\u8d77\u640f\u9608\u503c\u5448\u73b0\u7684\u5fc3\u7535\u56fe\u4e0e \u81ea\u53d1\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u5f62\u6210\u7684\u5fc3\u7535\u56fe\u662f\u5426\u5339\u914d\uff0c\u90e8\u5206\u591a\u5bfc\u7535\u751f\u7406\u523a\u6fc0\u4eea\u53ef\u81ea\u52a8\u8ba1\u7b97\u663e\u793a\u5339\u914d\u7a0b\u5ea6\uff0c\u5224\u65ad\u8d77\u640f \u4f4d\u7f6e\u4e0e\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u8d77\u6e90\u4f4d\u7f6e\u7684\u76f8\u5bf9\u5173\u7cfb\u3002\u4e0e\u4e3b\u52a8\u8109\u74e3-\u4e8c\u5c16\u74e3\u4ea4\u754c\u5904\u8f83\u539a\u7684\u5fc3\u808c\u7ec4\u7ec7\u4e0d\u540c\uff08\u56fe13\uff09,\u5bf9 \u4e8e\u4e3b\u52a8\u8109\u6839\u90e8\u8d77\u6e90\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\uff0c\u6fc0\u52a8\u6807\u6d4b\u8f83\u8d77\u640f\u6807\u6d4b\u66f4\u4e3a\u51c6\u786e\uff0c\u56e0\u4e3b\u52a8\u8109\u74e3\u4e0a\u5927\u90e8\u5206\u4e3a\u7ea4\u7ef4\u7ed3\u7f14\u7ec4\u7ec7\uff0c \u76f8\u5f53\u6bd4\u4f8b\u75c5\u4f8b\u8d77\u640f\u96be\u4ee5\u593a\u83b7\uff0c\u5373\u4f7f\u80fd\u591f\u8d77\u640f\u593a\u83b7\uff0c\u4e00\u822c\u8d77\u640f\u9608\u503c\u4e5f\u8f83\u9ad8\uff0c\u5e38\u9700\u8981\u8f83\u5927\u7684\u8f93\u51fa\u529f\u7387\uff0c\u6545\u9700 \u8981\u6ce8\u610f\u4ee5\u4e0b\u60c5\u51b5\uff1a\u2460\u8fd0\u7528\u9ad8\u8d77\u640f\u9608\u503c\u5728\u975e\u75c5\u7076\u533a\u57df\u8fdb\u884c\u8d77\u640f\u65f6\uff0c\u6240\u5f62\u6210\u7684\u8d77\u640f\u5fc3\u7535\u56fe\u53ef\u80fd\u4e0e\u81ea\u53d1\u7684\u5fc3\u7535\u56fe\u8868\u73b0\u4e00\u81f4\u3002\u4f8b\u5982\u8d77\u6e90\u4e8e\u53f3\u5ba4\u6d41\u51fa\u9053\u95f4\u9694\u9762\u6216\u662f\u5de6\u5ba4\u6d41\u51fa\u9053\u74e3\u4e0b\u7684\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\uff0c\u5728\u53f3\u51a0\u7aa6\u5185\u8fd0\u7528\u9ad8\u8d77 \u640f\u9608\u503c\u8fdb\u884c\u8d77\u640f\uff0c\u6240\u83b7\u5f97\u7684\u8d77\u640f\u5fc3\u7535\u56fe\u8868\u73b0\u4e0e\u81ea\u53d1\u5fc3\u7535\u56fe\u4e00\u81f4\uff0c\u9020\u6210\u4e86\u5bf9\u8d77\u6e90\u4f4d\u7f6e\u7684\u8bef\u5224\u65ad\u3002\u540c\u6837\uff0c\u5728 \u5fc3\u5927\u9759\u8109\u6216\u662f\u524d\u5ba4\u95f4\u9694\u9759\u8109\u8fd0\u7528\u9ad8\u8d77\u640f\u9608\u503c\u8fdb\u884c\u8d77\u640f\u65f6\uff0c\u5176\u8d77\u640f\u56fe\u5f62\u4e0e\u8d77\u6e90\u4f4d\u7f6e\u4f4d\u4e8e\u5de6\u51a0\u7aa6\u6216\u662f\u4e3b\u52a8\u8109 \u74e3\u4e8c\u5c16\u74e3\u4ea4\u754c\u5904\u7684\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u4e00\u81f4\uff1b\u2461\u4e3b\u52a8\u8109\u74e3\u4e0a\u8d77\u6e90\u7684\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u53ef\u80fd\u51fa\u53e3\u4e8e\u74e3\u4e0b\uff0c\u56e0\u800c\u5728\u74e3\u4e0a \u548c\u74e3\u4e0b\u8fdb\u884c\u8d77\u640f\uff0c\u53ef\u80fd\u5448\u73b0\u76f8\u540c\u7684\u5fc3\u7535\u56fe\u8868\u73b0\uff1b\u2462\u4e3b\u52a8\u8109\u74e3\u4e0a\u8d77\u6e90\u7684\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u5f88\u96be\u901a\u8fc7\u8d77\u640f\u7684\u65b9\u6cd5, \u4ea7\u751f\u4e0e\u81ea\u53d1\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u4e00\u81f4\u7684\u5fc3\u7535\u56fe\u8868\u73b0\u3002\u8fd9\u662f\u7531\u4e8e\u4f38\u5165\u81f3\u74e3\u4e0a\u7684\u808c\u8896\u5c11\u800c\u7ec6\uff0c\u8d77\u640f\u5f88\u96be\u593a\u83b7\u5c40\u90e8\u7684 \u808c\u8896\uff0c\u800c\u4e0d\u593a\u83b7\u5fc3\u5ba4\u808c\u3002\u65e0\u51a0\u7aa6\u4e34\u8fd1\u623f\u95f4\u9694\uff0c\u5728\u65e0\u51a0\u7aa6\u5185\u8d77\u640f\uff0c\u53ea\u663e\u793a\u593a\u83b7\u5fc3\u623f\u7535\u4f4d\uff0c\u800c\u4e0d\u593a\u83b7\u5fc3\u5ba4\u7535 \u4f4d\uff0c\u5373\u4f7f\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u8d77\u6e90\u4e8e\u65e0\u51a0\u7aa6\uff0c\u8d77\u640f\u6807\u6d4b\u65b9\u6cd5\u4e5f\u4e0d\u80fd\u8bc1\u5b9e\u5176\u4e3a\u8d77\u6e90\u4f4d\u7f6e\uff08\u56fe26-14,\u56fe26-15\uff09\u3002<\/p>\n<\/p>\n
\u56fe 26-14<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a1\u4f8b\u8d77\u6e90\u4e8e\u5de6\u51a0\u7aa6\uff08LCC \uff09\u5ba4\u6027\u65e9\u640f\u8d77\u640f\uff08PVC\uff09\u5fc3\u7535\u56fe\u7279\u70b9\u3002A\u56fe\u4e2d\u53f3\u5ba4\u6d41\u51fa\u9053\uff08RVOT\uff09 \u8d77\u640f\u768412\u5bfc\u8054\u4f53\u8868\u5fc3\u7535\u56fe\u56fe\u5f62\u6bd4LCC\u5185\u8d77\u640f\u66f4\u63a5\u8fd1PVC\u65f6\u56fe\u5f62\u3002B\u56fe\uff1a\u6d88\u878d\u9776\u70b9\u4f4d\u4e8eLCC\u5185\uff0c\u5fc3\u5ba4\u6ce2 \u63d0\u524d\u4f53\u8868\u5fc3\u7535\u56feQRS\u6ce2\uff08V.QRS\uff09 24ms, RVOT\u5904\u5fc3\u5ba4\u6ce2\u4e0d\u9886\u5148\uff0cB\u56fe\u53f3\u4fa7\u4e3a\u5de6\u524d\u659c\uff08LAO\uff09\u4e0e\u53f3\u524d\u659c \uff08RAO \uff09\u7684\u6d88\u878d\u5bfc\u7ba1\uff08ABL\uff09 X \u7ebf\u5f71\u50cf\u3002\uff08\u672c\u56fe\u5f15\u81ea Yamada T, Murakami Y,Yoshida N, et al. Preferential conduction across the ventricular outflow septum in ventricular arrhythmias originating from the aortic sinus cusp. J Am Coll Cardiol, 2007, 50:884-891 \uff09\u3002<\/p>\n<\/p>\n
\u56fe 26-15<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u5de6\u51a0\u7aa6\uff08LCC\uff09\u8d77\u640f\uff08\u84dd\u8272\u653e\u7535\u56fe\u5f62\uff09\u65f6\uff0cLCC\u8d77\u6e90\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u8d77\u6e90\u4f4d\u70b9\uff08\u7c89\u8272\u4e94\u89d2 \u661f\u5f62\uff09\u3001\u7a81\u7834\u53e3\uff08\u7c89\u8272\u661f\u53f7\u5f62\uff09\u53ca\u5411\u53f3\u5fc3\u5ba4\u6d41\u51fa\u9053\uff08RVOT\uff09\u6216\u5de6\u5ba4\u95f4\u9694\u4f18\u5148\u4f20\u5bfc\u9014\u5f84\u793a\u610f\u56fe\uff08\u672c\u56fe\u5f15\u81ea Yamada T, Murakami Y, Yoshida N, et al. Preferential conduction across the ventricular outflow septum in ventricular arrhythmias originating from the aortic sinus cusp. J Am Coll Cardiol, 2007, 50:884-891 \uff09\u3002<\/p>\n
5.\u62d6\u5e26\u6807\u6d4b \u4e3b\u52a8\u8109\u6839\u90e8\u8d77\u6e90\u7684\u5ba4\u6027\u5fc3\u52a8\u8fc7\u901f\u5f88\u5c11\u7531\u6298\u8fd4\u673a\u5236\u5f15\u8d77\uff0c\u6298\u8fd4\u5173\u952e\u901a\u9053\u7684\u786e\u5b9a\u57fa\u4e8e\u5b8c\u7f8e \u7684\u62d6\u5e26\u7ed3\u679c\uff0c\u540c\u65f6\u501f\u52a9\u4e8e\u4e09\u7ef4\u7535\u89e3\u5256\u7cfb\u7edf\u83b7\u53d6\u7535\u538b\u53ca\u6fc0\u52a8\u987a\u5e8f\u7b49\u4fe1\u606f\uff0c\u53ef\u8fdb\u4e00\u6b65\u589e\u52a0\u6210\u529f\u7387\uff0c\u540c\u65f6\u51cf\u5c11\u4e0d\u5fc5\u8981\u7684\u653e\u7535\u3002<\/p>\n
6.\u4e09\u7ef4\u7535\u89e3\u5256\u6807\u6d4b\u7cfb\u7edf \u4e09\u7ef4\u7535\u89e3\u5256\u6807\u6d4b\u7cfb\u7edf\u7684\u539f\u7406\u5efa\u7acb\u4e8e\u4f20\u7edf\u6807\u6d4b\u624b\u6bb5\uff0c\u53ef\u501f\u52a9\u4e8e\u4e09\u7ef4\u7535\u89e3\u5256\u6807 \u6d4b\u7cfb\u7edf\u5bf9\u4e3b\u52a8\u8109\u6839\u90e8\u5efa\u7acb\u7acb\u4f53\u51e0\u4f55\u6210\u50cf\uff0c\u540c\u65f6\u83b7\u53d6\u4e0d\u540c\u65f6\u523b\u6807\u6d4b\u548c\u6d88\u878d\u5bfc\u7ba1\u5934\u7aef\u7684\u4f4d\u7f6e\u548c\u5c40\u90e8\u5fc3\u5185\u7535\u56fe \u4e24\u79cd\u4fe1\u606f\uff0c\u5c06\u5fc3\u5185\u7535\u751f\u7406\u4fe1\u606f\uff08\u6fc0\u52a8\u65f6\u95f4\u548c\u7535\u538b\u7b49\uff09\u4e0e\u8154\u5185\u7a7a\u95f4\u89e3\u5256\u7ed3\u6784\u7ed3\u5408\u5728\u4e00\u8d77\uff0c\u786e\u5b9a\u5fc3\u52a8\u8fc7\u901f\u7684 \u6fc0\u52a8\u987a\u5e8f\uff0c\u6fc0\u52a8\u4f20\u5bfc\u7684\u65b9\u5411\u3001\u8def\u5f84\u548c\u8303\u56f4\uff0c\u660e\u786e\u5fc3\u5f8b\u5931\u5e38\u7684\u5c40\u7076\u6fc0\u52a8\u6216\u6298\u8fd4\u6fc0\u52a8\u673a\u5236\uff0c\u660e\u786e\u6709\u65e0\u75a4\u75d5\u57fa \u8d28\uff0c\u4e5f\u53ef\u878d\u5408CT\u5f71\u50cf\uff0c\u6709\u52a9\u4e8e\u63d0\u9ad8\u5bfc\u7ba1\u6d88\u878d\u7684\u6210\u529f\u7387\u3001\u964d\u4f4e\u590d\u53d1\u7387\u548c\u964d\u4f4eX\u7ebf\u8f90\u5c04\u91cf\u7b49\uff0c\u5e76\u53ef\u6807\u6ce8\u7279 \u6b8a\u90e8\u4f4d\uff0c\u5982\u5e0c\u6c0f\u675f\u3001\u51a0\u72b6\u52a8\u8109\u5f00\u53e3\u7b49\uff0c\u4ee5\u51cf\u5c11\u5e76\u53d1\u75c7\u53d1\u751f\uff0c\u5982\u6709\u6761\u4ef6\uff0c\u53ef\u501f\u52a9\u8154\u5185\u8d85\u58f0\u8fdb\u4e00\u6b65\u7cbe\u786e\u5b9a\u4f4d \uff08\u56fe 26-16,\u56fe 26-17\uff09\uff1b<\/p>\n<\/p>\n
\u56fe 26-16<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a\u4e09\u7ef4\u7535\u89e3\u5256\u7cfb\u7edf\u7acb\u4f53\u6210\u50cf\u4e3b\u52a8\u8109\u6839\u90e8\u53ca\u6bd7\u90bb\u7ed3\u6784\u3002\u4e0a\u56fe\u4e3a\u4e09\u7ef4\u7535\u89e3\u5256\u7cfb\u7edf\uff08CART 0\u7cfb\u7edf\uff09 \u5728\u4e0d\u540c\u4f53\u4f4d\u4e0b\u5bf9\u4ee5\u4e0b\u7ed3\u6784\u8fdb\u884c\u5efa\u6a21\uff0c\u5305\u62ec\u4e3b\u52a8\u8109\uff08Aorta\uff09\u6839\u90e8\u5de6\u51a0\u7aa6\uff08L\uff09\u3001\u53f3\u51a0\u7aa6\uff08R\uff09\u3001\u65e0\u51a0\u7aa6\uff08N\uff09\u3001 \u51a0\u72b6\u9759\u8109\uff08CS\uff09\u3001\u5fc3\u5927\u9759\u8109\uff08GCV\uff09\u3001\u524d\u5ba4\u95f4\u9694\u652f\uff08AIV\uff09\u3001\u53f3\u5fc3\u5ba4\u6d41\u51fa\u9053\uff08RVOT\uff09\u3001\u5de6\u5fc3\u5ba4\uff08LV\uff09\u3001 \u5de6\u5ba4\u95f4\u9694\uff08LVS\uff09\u3001\u53f3\u5fc3\u5ba4\uff08RV\uff09\u3001\u524d\u964d\u652f\uff08LAD\uff09\u3001\u56de\u65cb\u652f\uff08LCX\uff09\u7a7a\u95f4\u5173\u7cfb\u3002\u5e97=\u524d\u540e\u4f4d\uff1bLAO= \u5de6\u524d\u659c\u4f4d\uff1bLL=\u5de6\u4fa7\u5367\u4f4d\uff1b\uff1f\u5165=\u540e\u524d\u4f4d\uff1bRAO=\u53f3\u524d\u659c\u4f4d\uff1bSup=\u4e0a\u90e8\uff08\u672c\u56fe\u5f15\u81eaOuyang F, Mathew S, Wu S, et al. Ventricular arrhythmias arising from the left ventricular outflow tract below the aortic sinus cusps mapping and catheter ablation via transseptal approach and electrocardiographic characteristics. Circ Arrhythm Electrophysiol, 2014, 7: 445-455 \uff09\u3002<\/p>\n<\/p>\n
\u56fe26\u30fb17<\/p>\n
\uff08\u56fe\u6ce8\uff09\uff1a1\u4f8b\u8d77\u6e90\u4e8e\u65e0\u51a0\u7aa6\uff08NCC\uff09\u5ba4\u6027\u65e9\u640f\u7684\u4e09\u7ef4\u6fc0\u52a8\u56fe\u3001\u4e09\u7ef4\u7535\u89e3\u5256\u7cfb\u7edf\u91cd\u5efa\u4e3b\u52a8\u8109\u624d\u826e\u90e8\u56fe\u4e0e \u8154\u5185\u8d85\u58f0\u56fe\u3002\u5de6\u56fe\u63d0\u793a\u8be5\u5ba4\u6027\u65e9\u640f\u8d77\u6e90\u4e8eNCC\u5185\uff08\u7ea2\u70b9\uff09\uff0c\u53f3\u56fe\u4e3a\u8154\u5185\u8d85\u58f0\u660e\u786e\u8212\u5f20\u671f\uff08diastolic\uff09\u4e0e \u6536\u7f29\u671f\uff08systolic \uff09\u5176\u6d88\u878d\u5bfc\u7ba1\u4f4d\u4e8eNCC\u3002LCC=\u5de6\u51a0\u7aa6\uff0cRCC\uff1e\u53f3\u51a0\u7aa6\uff0cRVOT=\u53f3\u5fc3\u5ba4\u6d41\u51fa\u9053\uff0cHB=\u5e0c\u6c0f \u675f\uff0cTA=\u4e09\u5c16\u74e3\u73af\uff0cRV=\u53f3\u5fc3\u5ba4\uff0cAO=\u4e3b\u52a8\u8109\uff08\u672c\u56fe\u5f15\u81ea Yamada T, Lau YR, Litovsky SH et al. Prevalence and clinical, electrocardiographic, and electrophysiologic characteristics of ventricular arrhythmias originating from the noncoronary sinus of valsalva. Heart Rhythm 2013, 10: 1605-1612\uff09\u3002<\/p>\n
7.\u5c04\u9891\u6d88\u878d \u2460\u6d88\u878d\u529f\u7387\u4e0e\u6e29\u5ea6\u76ee\u524d\uff0c\u4e3b\u52a8\u8109\u7aa6\u5185\u6d88\u878d\u5df1\u5e38\u89c4\u4f7f\u7528\u51b7\u76d0\u6c34\u704c\u6ce8\u6d88\u878d\u5bfc\u7ba1\uff0c\u5728AMC \u9644\u8fd1\u533a\u57df\u6d88\u878d\u53ef\u9002\u5f53\u589e\u52a0\u529f\u7387\uff0c\u5e76\u6839\u636e\u538b\u529b\u6539\u5584\u5bfc\u7ba1\u8d34\u9760\u3002\u2461\u5b89\u5168\u6027a\uff1a\u5bf9\u5de6\u3001\u53f3\u51a0\u72b6\u7aa6\u8d77\u6e90\u8005\uff0c\u5728\u6d88\u878d\u524d\u53ef\u7ecf\u5bfc\u7ba1\u7684\u51b7\u76d0\u6c34\u63a5\u53e3\u5904\u63a8\u6ce8\u5c11\u91cf\u9020\u5f71\u5242\uff0c\u6216\u901a\u8fc7\u5c40\u90e8\u7535\u4f4d\uff0c\u89e3\u5256\u4f4d\u7f6e\u7b49\u8bc1\u5b9e\u5bfc\u7ba1\u5934\u7aef\u5728\u4e3b\u52a8\u8109\u7aa6 \u7684\u4f4d\u7f6e\u4ee5\u53ca\u548c\u51a0\u72b6\u52a8\u8109\u7684\u90bb\u8fd1\u5173\u7cfb\uff0c\u5982\u53d1\u73b0\u5bfc\u7ba1\u79fb\u4f4d\uff0c\u53ca\u65f6\u505c\u6b62\u653e\u7535\uff1bb:\u5bf9\u8ddd\u5de6\u51a0\u72b6\u52a8\u8109\u4e3b\u5e72\u6216\u8ddd\u5176\u4e3b \u5e72\u5f00\u53e3W0.5\u301clcm\u8d77\u6e90\u7684\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\uff0c\u56e0\u6d88\u878d\u53ef\u80fd\u635f\u4f24\u51a0\u72b6\u52a8\u8109\u5185\u819c\uff0c\u8bf1\u53d1\u6025\u6027\u5fc3\u808c\u6897\u6b7b\uff0c\u9700\u8c28\u614e\u6d88\u878d\uff1b c\uff1a\u5bf9\u65e0\u51a0\u7aa6\u6216\u53f3\u51a0\u7aa6\u5e95\u8d77\u6e90\u8005\uff0c\u5c40\u90e8\u4e0d\u5e94\u8bb0\u5f55\u5230\u5e0c\u6c0f\u675f\u7535\u4f4d\uff0c\u6d88\u878d\u65f6\u9700\u4e25\u5bc6\u76d1\u6d4b\u6709\u65e0\u4ea4\u754c\u6027\u5fc3\u5f8b\u53caPR \u95f4\u671f\u5ef6\u957f\uff1bd\uff1a\u5728\u6d88\u878d\u5f00\u59cb\u540e\u768410\u79d2\u5185\uff0c\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u672a\u89c1\u660e\u663e\u51cf\u5c11\uff0c\u5efa\u8bae\u505c\u6b62\u6d88\u878d\uff0c\u7ee7\u7eed\u5bfb\u627e\u8d77\u6e90\u4f4d \u7f6e\u3002\u5982\u679c\u5728\u6d88\u878d\u5f00\u59cb\u540e\u768410\u79d2\u5185\uff0c\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u660e\u663e\u51cf\u5c11\u6216\u662f\u505c\u6b62\u8f6c\u4e3a\u7aa6\u5f8b\uff0c\u5219\u7ee7\u7eed\u653e\u753530\u301c60\u79d2\uff1be\uff1a \u5bf9\u4e8e\u8d34\u9760\u8f83\u4e3a\u56f0\u96be\u7684\u60a3\u8005\uff0c\u53ef\u501f\u52a9Swartz\u9798\u7ba1\u6216Aglilis\u9798\u7ba1\u589e\u52a0\u6d88\u878d\u5bfc\u7ba1\u7a33\u5b9a\u6027\u6216\u6d3b\u52a8\u8303\u56f4\uff0c\u90e8\u5206\u60a3\u8005 \u53ef\u7ecf\u7a7f\u623f\u95f4\u9694\u9014\u5f84\u5230\u8fbe\u7406\u60f3\u9776\u70b9\u5904\uff1b\u2462\u6d88\u878d\u7ec8\u70b9\u4e3a\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u6d88\u5931\uff0c\u5e76\u4e14\u9759\u8109\u70b9\u6ef4\u5f02\u4e19\u80be\u4e0a\u817a\u7d20\u6216\u5bf9 \u4e8e\u6298\u8fd4\u673a\u5236\u5ba4\u901f\u4f7f\u7528\u5fc3\u5ba4Burst\u523a\u6fc0\u4e0d\u80fd\u8bf1\u53d1\u3002<\/p>\n
\u4e94\u3001\u5c0f\u7ed3<\/p>\n
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